Lucas G, Accadbled F, Violas P, Sales de Gauzy J, Knörr J
Service de chirurgie pédiatrique, hôpital Sud, boulevard de Bulgarie, 35200 Rennes, France.
Service de chirurgie pédiatrique, hôpital d'Enfants Purpan, place du Docteur-Baylac 31059 Toulouse cedex 9, France.
Orthop Traumatol Surg Res. 2015 Apr;101(2):173-7. doi: 10.1016/j.otsr.2014.12.006. Epub 2015 Feb 9.
The management of isolated meniscal tears in paediatric patients is poorly standardised, and few published data are available. Nevertheless, there is widespread agreement that meniscectomy, even when partial, produces poor outcomes including the premature development of osteoarthritis.
Arthroscopic repair of isolated meniscal tears in paediatric patients yields good outcomes and should be attempted routinely.
We retrospectively assessed 19 arthroscopic repair procedures performed between 2006 and 2010 by a single surgeon in 17 patients with a mean age of 14 years. In every case, the knee was stable and the meniscus normal before the meniscal tear, which was the only injury. Mean follow-up was 22 months. In all 19 cases, the evaluation included a physical examination, pre-operative magnetic resonance imaging (MRI), and determination of the Tegner and Lysholm scores. Post-operative MRI was performed in 10 cases.
The outcome was good in 12/17 (70%) patients with significant improvements in the mean Tegner score, from 3.9 to 7.1, and mean Lysholm score, from 55.9 to 85.4, between the pre-operative and post-operative assessments. The clinical outcomes were not significantly associated with time to arthroscopic repair, gender, lesion site, or lesion type. Neither was any correlation demonstrated between clinical outcomes and meniscal healing as assessed by MRI.
The known poor outcomes after meniscectomy in paediatric patients, the results of our study, and previously published data support routine arthroscopic repair of isolated meniscal tears in this age group, regardless of the site and type of injury. In addition, in asymptomatic patients, clinical follow-up is sufficient and post-operative MRI unnecessary.
Level IV. Retrospective study.
小儿患者孤立性半月板撕裂的治疗缺乏标准化，且鲜有公开数据。然而，人们普遍认为半月板切除术，即使是部分切除术，都会产生不良后果，包括过早发生骨关节炎。
小儿患者孤立性半月板撕裂的关节镜修复效果良好，应常规尝试。
我们回顾性评估了2006年至2010年间由一名外科医生对17例平均年龄14岁的患者实施的19例关节镜修复手术。在每种情况下，半月板撕裂是唯一的损伤，且在撕裂前膝关节稳定，半月板正常。平均随访时间为22个月。在所有19例病例中，评估包括体格检查、术前磁共振成像（MRI）以及Tegner和Lysholm评分的测定。10例患者进行了术后MRI检查。
17例患者中有12例（70%）效果良好，术前和术后评估之间，平均Tegner评分从3.9显著提高到7.1，平均Lysholm评分从55.9提高到85.4。临床结果与关节镜修复时间、性别、损伤部位或损伤类型无显著相关性。MRI评估的半月板愈合情况与临床结果之间也未显示出任何相关性。
小儿患者半月板切除术后已知的不良后果、我们的研究结果以及先前发表的数据均支持对该年龄组的孤立性半月板撕裂进行常规关节镜修复，无论损伤的部位和类型如何。此外，对于无症状患者，临床随访就足够了，术后无需进行MRI检查。
IV级。回顾性研究。
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